Variceal bleeding: management options

Abstract

Portal hypertension with esophageal varices represents an important source of upper gastrointestinal bleeding. Variceal bleeding is associated with high rebleeding and mortality rates. Various treatment modalities are effective in control of bleeding. Endoscopic Sclerotherapy (ES) is the standard method for management of acute variceal bleeding alone or in combination with vasoactive drugs. Alternative methods are considered in case of sclerotherapy failure. Portosystemic shunt operation is complicated by systemic encephalopathy. Therefore, it is replaced by other surgical procedures. These include esophageal stapled transection, splenectomy with devascularization, distal splenorenal shunt (DSRS), DSRS combined with pancreatic disconnection, narrow diameter mesocaval (NDMC) or portocaval (NDPC) shunts and liver transplantation. Recently. transjugular intrahepatic portosystemic stent-shunting (TIPSS) has been introduced in the management of patients with refractory variceal bleeding waiting for liver transplantation.